Question: I would like to ask Evan Harris what evidence there is that politicians have grasped the nettle about honest debate on resource allocation, particularly as it concerns cardiovascular disease?

Evan Harris: There is very little evidence. I would not argue for more and more resources now. The money that was announced in the budget is probably about as much as the service can take because there is such a shortage of things to spend it on due to the true constraint of staffing. What I do think, however, is that we can spend this money better. The refrain I always hear is that too much of the resource is going into secondary care because of the nature of the targets being set. I’m not arguing that the targets in the national service frameworks are wrong, but the ones we hear about are these obsessive waiting list targets and A&E targets—the ones with the political premium—and the resources are going into these with no evidence of benefit. There is not enough resource going into health promotion (for example, diet/exercise), prevention (screening, etc) and primary care (for example, smoking cessation clinic funding). Given the data on the cost effectiveness of smoking cessation relative to other treatments, there is a duty on the powers that be, and I don’t believe this should be politicians but public health people with control over commissioning, to put resources into those areas in preference to other things that are less cost effective.

Joyce Cramer: Issues such as smoking cessation, diet, and exercise are more public health issues than …